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Regional filling characteristics of the lungs in mechanically ventilated patients with acute lung injury

Published online by Cambridge University Press:  01 May 2007

J. Hinz ,
A. Gehoff ,
O. Moerer ,
I. Frerichs ,
G. Hahn ,
G. Hellige  and
M. Quintel
J. Hinz*
Affiliation:
University of Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Kiel, Germany
A. Gehoff
Affiliation:
University of Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Kiel, Germany
O. Moerer
Affiliation:
University of Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Kiel, Germany
I. Frerichs
Affiliation:
University Hospital Schleswig-Holstein, Department of Anaesthesiology and Intensive Care Medicine, Campus Kiel, Kiel, Germany
G. Hahn
Affiliation:
University of Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Kiel, Germany
G. Hellige
Affiliation:
University of Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Kiel, Germany
M. Quintel
Affiliation:
University of Göttingen, Emergency and Intensive Care Medicine, Department of Anaesthesiology, Göttingen, Kiel, Germany
*
Correspondence to: José Hinz, Department of Anaesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Robert-Koch-Str. 40, D-37075 Göttingen, Germany. E-mail: mail@josehinz.de; Tel: +49 5513 92995; Fax: +49 5513 98470
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Summary

Objectives

The objective of the study was to determine regional pulmonary filling characteristics in 20 mechanically ventilated patients with acute lung injury.

Methods

Regional filling characteristics were calculated from tracings of regional tidal volumes vs. global tidal volumes measured by electrical impedance tomography (EIT). These plots were fitted to a polynomial function of the second degree. Regional polynomial coefficients of the second degree characterized the curve linearity of the plots. Near-zero values of the polynomial coefficient indicated a homogeneous increase in regional tidal volumes during the whole inspiration. Positive values hinted at initial low regional tidal volume change suggesting lung volume recruitment. Negative values indicated late low regional tidal volume change implying hyperinflation of this lung region.

Results

We found a broad heterogeneity of regional lung filling characteristics. The minimal regional polynomial coefficients varied from −2.80 to −0.56 (median −1.16), while the maximal regional polynomial coefficients varied from 0.58 to 3.65 (median 1.41).

Conclusions

Measurements of regional filling characteristics by EIT may be a helpful tool to adjust the respiratory settings during mechanical ventilation to optimize lung recruitment and to avoid overdistension. It applies a non-pressure-related assessment to the mechanics of lung inflation and gives a view of the real problems underlying ventilatory strategies dependent on global characteristics.

Keywords

ELECTRICAL IMPEDANCE TOMOGRAPHY, electrical impedanceRESPIRATORY PHYSIOLOGYRESPIRATION ARTIFICIALVENTILATION PERFUSION RATIOACUTE LUNG INJURY
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 24 , Issue 5 , May 2007 , pp. 414 - 424
Copyright
Copyright © European Society of Anaesthesiology 2006

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